| NPI | 1093704942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2002009364) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2002009364) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MO 2002009364) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2021-11-15 |